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Tuesday, July 29, 2014

SL Letter of the Day: Sex After HPV

Posted by on Tue, Jul 29, 2014 at 11:20 AM

I am on vacation for another week. But I've invited Dr. Lori Brotto to handle the Savage Love Letters of the Day. Dr. Lori Brotto is a clinical psychologist and sex researcher at the University of British Columbia in Vancouver. You can follow her on twitter @DrLoriBrotto, take part in her studies here and hear her chat about cultivating sexual satisfaction here. Dr. Brotto will be answering your questions all week.

I just got a call from my Dr. that I tested positive for HPV. I know that pretty much everyone has a strain of this and it’s not a huge deal. She said there was nothing to worry about because it wasn’t one of the cancer causing strains and that there was nothing to be done except to check it again in 6 months or a year. The dilemma is that I am 45 years old, married and monogamous with the same guy for the past 16 years. Prior to that I was with one guy for 7 years. I did have other partners before that, when I was in my teens. 

I totally trust my husband’s response that he hasn’t been with anyone else. He’s a good guy and I can’t imagine he’d lie to me about this. And I think he’d also trust me to be reasonable about any infidelity that might have occurred. 

However, I’m confused as to why my test turned up positive? From all that I’ve read it seems that if I was infected 25 years ago my body would have rid itself of the virus by now unless it was one of the bad strains, which would then be causing pre-cancerous lesions. I’ve had a PAP every year since I was about 18, and this is the first non-regular result. My Dr. did say that they have new PAP screening guidelines, so a lot more cases are showing up.

A lot of the online literature seems unclear/contradictory. I’m very healthy, don’t smoke, but I am going through some stuff related to long-term anxiety and stress that is finally being dealt with. Could something like that cause me to be so immune compromised that my body wouldn’t repress the virus? Also, as for sex, now what? Am I contagious in a way that is going to be a problem for my husband? I assume he also is infected but will there be a back and forth situation? I don’t seem to have any noticeable warts or any symptoms at all. But I’m feeling a little contaminated.

I just don’t know what to think about all of this so any insight would be really helpful.

No Clever Acronym

PS - I am definitely going to get my son vaccinated for this in a few years, when he’s old enough!


Dr. Brotto's response after the jump...

Even if you have been living in a cardboard box for the past decade, I am sure you have heard chatter about HPV, or Human Papillomavirus – a sexually transmitted infection that has been around for nearly a century. If your genitals have come into contact with those of another person, there is a high chance that you have been exposed to one of the over 40 different strains of HPV. Being a carrier of HPV does not mean you’ve been sexually reckless since if we were to test for the virus among your circle of friends, about 8/10 would also screen positive for HPV, even though most would not show symptoms, warts, or other signs of infection. Since 2006, the first vaccine against HPV has been approved and available in the US, Canada (where I’m writing to you from) and around the world. There are now two different HPV vaccines to choose from (Gardasil and Cervarix) and they are given typically in 3 shots over a 6 month period—ideally before someone has had their first romp and been exposed to the virus, as early as 9 years old. These vaccines protect against some of the HPV strains that will cause cervical cancer in women (types 16 and 18). Gardasil also protects against strains 6 and 11, which are usually the cause of genital warts. Gardasil is also approved for boys aged 9-26 since HPV can be transmitted between partners, and some strains cause cancers of the penis, anus, and oral cavity.

Your dilemma, NCA, is that you’ve just found out about having HPV. Let’s assume that, indeed, you and your partner have been exclusively sexually monogamous since you first hooked up 16 years ago (by the way, penile-vaginal intercourse is not the only way to transmit the virus), it is most likely that one of you (and possibly both) had the virus from a previous lover and what you have is not a new infection. So why would your test turn up positive now? Pap tests, which have been around for many decades, do not test for HPV, but for abnormal cells that might lead to cervical cancer. Currently, women can have the HPV co-test with their Pap smear, which is the best way of knowing if you are a carrier of the virus, but the co-test is not routinely done during a pap screen, unless that test came back with abnormal findings. Also, keep in mind that HPV testing is only sensitive to the cancer-causing strains of HPV, and not all of them. Since most people “clear” the virus (in other words, the body is able to fight it off), it may be that you and your partner have been passing it back and forth to each other in between periods of “clearing” it. And, though most people do clear the virus, age is not on your side as this ability lessens over time.

NCA, you ask whether your current stress may be compromising your body’s ability to clear the virus. Research out of Harvard Medical School shows that everyday stressors can lessen your ability to clear the virus, so this may be contributing in your case. For sanity’s sake, try to reel in that stress and there are plenty of drug-free ways to do that!

Ok, let’s get to sex and your real question. Is there sex after HPV? Of course there is! You’ve been doing the deed fret-free for years while probably carrying HPV (or transmitting it back and forth to your partner). Anxiety over your new knowledge will likely do more damage than the virus itself.

According to gynaecologic oncologist and HPV expert, Dr. Jessica McAlpine (from University of British Columbia), the best proactive action you (and your partner) could take is to get the HPV vaccine NOW. Even though the vaccine will not have the same protective benefits as it would in the sex naïve pre-teen, having the vaccine will improve your ability to fight HPV and reduce the chance of swapping it with your partner. Plus, the vaccine will lower the risk of HPV-related problems in many of your woman-parts (cervix, vagina, and vulva). Unfortunately, you’ll need to shell out your own cash for this as the vaccine is not covered by insurance plans for this type of situation.

Now here is my advocacy pitch. Readers: stop stigmatizing those with HPV, and push our school sex education programs to enforce these vaccination programs. Vaccinate your boys early (and don't pretend that your son is waiting until prom night). And for Christ’s sake, turn off Katie Couric!


Comments (14) RSS

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I'm in my late '30s and live in Seattle. A few years ago, I was in a relationship with someone with the genital warts version of HPV. I called both my Dr. and local public health dept about getting the HPV vaccine and was refused -- I was told the vaccine was only approved for the one (young; it's like 9-11) age group. So it wasn't a matter of payment; I was willing to pay out-of-pocket. They said they simply could not go "off-label" and give it to me.

Although I'm not having sex with that person anymore, I'm still curious about whether Dr. Brotto's response (for a 45-yr-old to get the HPV vaccine now) is accurate/feasible. What changed that would allow vaccination of a 45-yr-old? Was it FDA/CDC guidance? Clinician/public health practices? Is it that Dr. Brotto is only talking about Canadian law? Or did I just get bad info at the time?
Posted by Dudley on July 29, 2014 at 11:56 AM · Report this
@1I think you got bad info. I got vaccinated several years ago in my mid 20s in TX, after being sexually active for several years and already testing positive for some strain of HPV.
Posted by neverdidlikeyou on July 29, 2014 at 12:17 PM · Report this
I asked our son's doctor about this, because I saw a sign in the office saying to get daughters vaccinated, and she agreed that the sign was old, and our son should be vaccinated when he gets older (he's 2 months old atm). Even if there aren't/weren't negative health effects for boys, preventing cervical cancer is a good enough reason to get our son vaccinated.
Posted by Hanoumatoi on July 29, 2014 at 12:36 PM · Report this
fletc3her 5
I'd like to get the HPV vaccine just to be up to date on all the vaccines I can get. I'll have to ask about it.
Posted by fletc3her on July 29, 2014 at 1:48 PM · Report this
blip 6
@1, It's indicated for people up to age 26 but anyone can get it. If you're over 26 you will have to pay out of pocket and it's not cheap. If you want protection against warts make sure you're getting Gardasil and not Cervarix. I think Gardasil is the more common version of the vaccine out there but both have FDA approval.

That said, if you think you've already been exposed it's pointless to get vaccinated.
Posted by blip on July 29, 2014 at 1:53 PM · Report this
nartweag 7
Get a better doctor!
I am also in my mid-late 30's and got the vaccine a couple years ago, as I have multiple partners. I had zero issue and insurance actually paid for it (UW Medical Clinics and Regence Blue Shield).
Posted by nartweag on July 29, 2014 at 1:54 PM · Report this
Hey Doc, please avoid saying they'll have to pay for the vaccine out of pocket. While it's likely, it's not universally true. There are health plans that cover HPV vaccination as part of preventative care. My employers health savings plan has covered HPV for several years (100% with no deductible or co-insurance) and my read is that NCA's situation would have been covered also. I've heard of other plans with good preventative care having HPV coverage as well.

Patients should be encouraged to check out their plan's actual coverage instead of assuming there is a disincentive that might not actually exist for them.
Posted by Brian Murphy on July 29, 2014 at 1:55 PM · Report this
@6, "That said, if you think you've already been exposed it's pointless to get vaccinated."

According to my doc way back when, that's not true. Like the article says there are 40+ strains of HPV, so vaccination could still protect you against a strain you haven't been exposed to. That said, I would absolutely defer to an actual medical doctor on this point.
Posted by neverdidlikeyou on July 29, 2014 at 2:02 PM · Report this
AFinch 10
Heh...nice that she isn't accusing her husband. The distinction that most people may carry it symptom free for years is lost on most of the public.

Here's what else is lost on most people: the distinction between HPV and HSV - and even worse: between HSV-1 and HSV-2. I'm kind of gob smacked by how badly these things are all conflated and equated to the relative worst (most slut-shamey) among them: HSV-2.
Posted by AFinch on July 29, 2014 at 2:07 PM · Report this
blip 11
@9, If you have already been exposed to a specific strain that is covered by the vaccine (as @1 believes) and you want to get vaccinated because you are worried about that specific strain, the vaccine is not going to protect you from that specific strain. In that regard it is pointless, but otherwise you are correct, getting protection against the other strains is not pointless. Careless wording on my part.
Posted by blip on July 29, 2014 at 2:35 PM · Report this
dwightmoodyforgetsthings 12
@3- I find it hard to believe you gave birth to an automated teller machine.
Posted by dwightmoodyforgetsthings on July 29, 2014 at 6:25 PM · Report this
How is it that you're able to list off all these different types of HPV, yet when I got tested and came up positive, my doctor had no idea what the fuck I was talking about when I asked them what type I had?
Posted by treehugger on July 30, 2014 at 7:53 AM · Report this
Chiming in as another person who got Guardasil 'off-label' as a straight male in my 30s. I got it from the fourth doctor I asked. I tried with three Primary Care Docs, who first used the excuse it wasn't approved for males (true at the time), then I was too old (true at the time), then I wasn't sexually promiscuous enough (insensitively phrased by the doc).

Finally my dermatologist gave the referral because some strains of HPV cause plantar warts, and I had persistent issues with plantar warts. Like others, I got three rounds of Gardasil covered through my insurance (but only because I was persistent, and didn't take the first three answers). I haven't had any plantar warts since.
Posted by AdamWashington on July 30, 2014 at 11:13 AM · Report this
@14. Because there are times where patients are more informed than docs on certain topics. The best doctors will say "Educate me" or "Tell me more" when this happens.
Meh doctors will just move on to the next patient. Doctors with crappy customer service skills will try to get you to stop asking questions, or feel bad.
Posted by AdamWashington on July 30, 2014 at 11:18 AM · Report this

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